Pulse wave velocity (PWV) is a simple, reproducible and non-invasive technique to assess arterial stiffness. It estimates the velocity of arterial wave propagation to travel a known distance between two anatomic sites within the arterial system [1]. PWV has been established as an independent predictor of cardiovascular mortality and is consequently used for diagnosis and prognosis in patients at risk of atherosclerotic cardiovascular disease [2]; however, PWV's significance relies on the fact that arterial stiffness, specially of muscular arteries can be modified by interventions that improve endothelial function such as exercise training, which makes PWV an important tool for cardiovascular risk management [3].
- pulse wave velocity
- cardiovascular risk
- arterial stiffness
- vascular function
Definition1. Definition
Please provide an accurate concept or description at the top and briefly highlight the importance or benefits for humans.
Pulse wave velocity (PWV) is a simple, reproducible and non-invasive technique to assess arterial stiffness. It estimates the velocity of arterial wave propagation to travel a known distance between two anatomic sites within the arterial system [1]. PWV has been established as an independent predictor of cardiovascular mortality and is consequently used for diagnosis and prognosis in patients at risk of atherosclerotic cardiovascular disease [2]; however, PWV's significance relies on the fact that arterial stiffness, specially of muscular arteries can be modified by interventions that improve endothelial function such as exercise training, which makes PWV an important tool for cardiovascular risk management [3].
Introduction
2. Introduction
Pulse wave velocity (PWV) is considered the gold standard method for assessing aortic stiffness [4][5]. Arterial stiffness measures, and carotid femoral PWV (cfPWV) in particular, are being included in the routine clinical assessment of patients and within the framework of large-scale clinical studies [4] as new instrumental solutions that allow the PWV assessment, such as photoplethysmography or magnetic resonance emerge [6] (Table 1). Nevertheless, an introduction into clinical practice has not been implemented further due to the fact that there is a lack of established reference values based on a large population and due to the absence of a standardized methodology for PWV assessment [7].
3. Methods used to Determine PWV
Table 1. Methods used to determine PWV. aPWV: aortic pulse wave velocity; baPWV: brachial-ankle pulse wave velocity; cfPWV: carotid-femoral pulse wave velocity; DVP: digital volume pulse; ECG: electrocardiogram; PWV: pulse wave velocity.
|
|
Method |
Description |
Measure |
|
Non-invasive methods |
Applanation tonometry |
Apply a pressure sensor through the skin and applanate a superficial artery by applying a downward pressure sufficient to flatten the artery. |
baPWV, cfPWV |
|
Computerized oscillometry |
Simultaneous acquisition and analysis of the pulsation of the artery, which is caused by the heart, as the pressure oscillation in the cuff. |
Heart-brachial PWV, heart-ankle PWV, brachial-ankle PWV, cfPWV | |
|
Mechanotransducer |
Two dedicated piezoelectric pressure mechanotransducers directly applied to the skin in a simultaneous measurement of pressure pulses |
carotid–femoral, carotid–brachial or femoral–dorsalis pedis PWV | |
|
Ultrasound |
Doppler pulses are recorded sequentially in 2 different arterial sites and compared using the R-wave of the ECG |
baPWV, cfPWV | |
|
Photoplethysmography |
DVP measured by the photoplethysmography transducer |
DVP associated with aPWV | |
|
Magnetic Resonance Imaging |
Assessment of the blood flow velocity with an enough temporal and spatial resolution to study the propagation of the aortic systolic flow wave |
Local PWV | |
|
Invasive methods |
Aortic angiography |
Intra-aortic catheter measurements |
Local PWV |
Previous meta-analyses have attempted to calculate quantitative estimates of the predictive value of PWV for different outcomes. However, to the best of our knowledge, no previous meta-analysis has estimated the predictive performance (diagnostic odds ratio (dOR), sensitivity, specificity, positive likelihood ratio (PLR), and negative likelihood ratio (NLR)) of PWV considering the thresholds for a higher risk of cardiovascular or all-cause mortality estimated using hierarchical summary receiver operating characteristic (HSROC) models. Moreover, reference values for PWV have been established through cross-sectional studies [7] or expert consensus [8], in which subjects by age and blood pressure categories with no additional identified cardiovascular risk factors were considered.
References
- James Oliver; David J. Webb; Noninvasive Assessment of Arterial Stiffness and Risk of Atherosclerotic Events. Arteriosclerosis, Thrombosis, and Vascular Biology 2003, 23, 554-566, 10.1161/01.atv.0000060460.52916.d6.
- Tomoki Shokawa; Michinori Imazu; Hideya Yamamoto; Mamoru Toyofuku; Naohito Tasaki; Tomokazu Okimoto; Kiminori Yamane; Nobuoki Kohno; Pulse Wave Velocity Predicts Cardiovascular Mortality. Circulation Journal 2005, 69, 259-264, 10.1253/circj.69.259.
- Michael F. O’Rourke; Junichiro Hashimoto; Arterial Stiffness. Journal of Cardiopulmonary Rehabilitation and Prevention 2008, 28, 225-237, 10.1097/01.hcr.0000327179.21498.38.
- G. Mancia; G. De Backer; Anna Dominiczak; Renata Cífková; R. Fagard; Giuseppe Germano; Guido Grassi; Anthony Heagerty; S. E. Kjeldsen; Stéphane Laurent; et al.Krzysztof NarkiewiczLuis Miguel RuilopeAndrzej RynkiewiczR. E. SchmiederH. A.J. Struijker-BoudierA. ZanchettiAlec VahanianJohn CammRaffaele De CaterinaVeronica DeanKenneth DicksteinG. FilippatosChristian Funck-BrentanoIrene HellemansSteen Dalby KristensenKeith McGregorUdo SechtemSigmund SilberMichal TenderaPetr WidimskyJ. L. ZamoranoS. ErdineW. KiowskiE. Agabiti-RoseiE. AmbrosioniLars H. LindholmA. J. ManolisPeter M. NilssonJ. RedonM. ViigimaaStamatis AdamopoulosVicente BertomeuDenis ClementCsaba FarsangDan GaiţăGregory LipJean-Michel MallionE. OʼbrienPiotr PonikowskiFrank RuschitzkaJuan TamargoPieter Van ZwietenBernard WaeberBryan WilliamsESC Committee for Practice Guidelines (CPG):Esh Scientific Council:Document Reviewers:Athanasios J. Manolis 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). European Heart Journal 2006, 28, 1462-1536, 10.1093/eurheartj/ehm236.
- Raymond Townsend; Ian B. Wilkinson; Ernesto L. Schiffrin; Alberto P. Avolio; Julio A. Chirinos; John R. Cockcroft; Kevin S. Heffernan; Edward G. Lakatta; Carmel M. McEniery; Gary F. Mitchell; et al.Samer S. NajjarWilmer W. NicholsElaine M. UrbinaThomas WeberAmerican Heart Association Council on Hypertension Recommendations for Improving and Standardizing Vascular Research on Arterial Stiffness: A Scientific Statement From the American Heart Association.. Hypertension 2015, 66, 698-722, 10.1161/HYP.0000000000000033.
- Tania Pereira; Carlos Correia; João Cardoso; Novel Methods for Pulse Wave Velocity Measurement. Journal of Medical and Biological Engineering 2015, 35, 555-565, 10.1007/s40846-015-0086-8.
- Reference Values for Arterial Stiffness' Collaboration; The Reference Values for Arterial Stiffness' Collaboration; Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: 'establishing normal and reference values'.. European Heart Journal 2010, 31, 2338-50, 10.1093/eurheartj/ehq165.
- Luc M. Van Bortel; Stéphane Laurent; Pierre Boutouyrie; Phil Chowienczyk; J.K. Cruickshank; Tine De Backer; Jan Filipovsky; Sofie Huybrechts; Francesco U.S. Mattace-Raso; Athanase D Protogerou; et al.Giuseppe SchillaciPatrick SegersSebastian VermeerschThomas Weber Expert consensus document on the measurement of aortic stiffness in daily practice using carotid-femoral pulse wave velocity. Journal of Hypertension 2012, 30, 445-448, 10.1097/hjh.0b013e32834fa8b0.